Hypernatremia in the Neonate: Neonatal Hypernatremia and Hypernatremic Dehydration in Neonates Receiving Exclusive Breastfeeding.

AIMS AND OBJECTIVES: Evaluation of neonatal hypernatremia and hypernatremic dehydration in neonates receiving exclusive breastfeeding. INTRODUCTION: Neonatal hypernatremia is a serious condition in the newborn period. We present infants with hypernatremic dehydration due to breast milk (BM) hypernatremia. Hypernatremic dehydration in breast-fed newborns is usually secondary to insufficient lactation. We present the neonatal hypernatremia and hypernatremic dehydration encountered between January and December, 2012, its causes and treatment. METHODOLOGY: This was a retrospective study. We analyzed records of babies admitted to the Neonatal Intensive Care Unit who were investigated and found to have hypernatremia and whose mother's BM sodium (BM Na) was done. INCLUSION CRITERIA: (1) Babies with serum Na >145 meq/l, (2) euglycemia, (3) normocalcemic, (4) no clinical and lab evidence of sepsis, (5) exclusive breast feeds. EXCLUSION CRITERIA: Neonates not satisfying any mentioned criterion. RESULTS: BM Na correlated strongly with neonatal hypernatremia in exclusively breast-fed babies who did not otherwise have any risk factor. CONCLUSION: Elevated BM Na is an important etiological factor in neonatal hypernatremia.

Helping Babies Breathe (HBB) training: What happens to knowledge and skills over time?

BACKGROUND: The first minutes after birth are critical to reducing neonatal mortality. Helping Babies Breathe (HBB) is a simulation-based neonatal resuscitation program for low resource settings. We studied the impact of initial HBB training followed by refresher training on the knowledge and skills of the birth attendants in facilities. METHODS: We conducted HBB trainings in 71 facilities in the NICHD Global Network research sites (Nagpur and Belgaum, India and Eldoret, Kenya), with a 6:1 ratio of facility trainees to Master Trainers (MT). Because of staff turnover, some birth attendants (BA) were trained as they joined the delivery room staff, after the initial training was completed (catch-up initial training). We compared pass rates for skills and knowledge pre- and post- initial HBB training and following refresher training among active BAs. An Objective Structured Clinical Examination (OSCE) B tested resuscitation skill retention by comparing post-initial training performance with pre-refresher training performance. We identified factors associated with loss of skills in pre-refresher training performance using multivariable logistic regression analysis. Daily bag and mask ventilation practice, equipment checks and supportive supervision were stressed as part of training. RESULTS: One hundred five MT (1.6 MT per facility) conducted initial and refresher HBB trainings for 835 BAs; 76% had no prior resuscitation training. Initial training improved knowledge and skills: the pass percentage for knowledge tests improved from 74 to 99% (p < 0.001). Only 5% could ventilate a newborn mannequin correctly before initial training but 97% passed the post-initial ventilation training test (p < 0.0001) and 99% passed the OSCE B resuscitation evaluation. During pre-refresher training evaluation, a mean of 6.7 (SD 2.49) months after the initial training, 99% passed the knowledge test, but the successful completion rate fell to 81% for the OSCE B resuscitation skills test. Characteristics associated with deterioration of resuscitation skills were BAs from tertiary care facilities, no prior resuscitation training, and the timing of training (initial vs. catch-up training). CONCLUSIONS: HBB training significantly improved neonatal resuscitation knowledge and skills. However, skills declined more than knowledge over time. Ongoing skills practice and monitoring, more frequent retesting, and refresher trainings are needed to maintain neonatal resuscitation skills. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01681017 ; 04 September 2012, retrospectively registered.

Is knowledge of medicolegal issues concordant with heightened risk among doctors?

Spurred by the wave of consumerism, patients do not hesitate to drag the doctor to the court. It has now become essential for doctors to educate themselves on the laws relevant to medical practice. This study addresses some of the issues. Doctors in private practice, belonging to different specialities, were given a self administered questionnaire which was then analysed by the percentage of responses to each question. Only 3% of the respondents faced medicolegal problems at the time of the study. All of them were fighting charges of negligence from their patients. Most (97%) did not keep records of patients seen in outpatient services, 63% used consent forms written in English only and 78% took blanket consent forms for procedures; 97% were not aware of any laws protecting them in their practice. This study highlights the gross ignorance of medicolegal issues among doctors and the need for compulsory certificate courses for them and changes in the curriculum for the postgraduates with respect to this important aspect of medical profession.

DOOR syndrome.

DOOR syndrome is a rare multisystem genetic disorder, consisting of deafness (sensorineural), onychodystrophy, osteodystrophy, and mental retardation. Seizures reported frequently in this condition are often refractory to treatment.

Panayiotopoulos syndrome.

Panayiotopoulos syndrome is a benign childhood epileptic illness characterized by episodic autonomic symptoms. We present a 9 year old boy with this condition, who presented with episodes of severe vomiting, fever, deviation of eyes and altered sensorium, characteristic EEG in the form of multiple occipital spikes and normal neuroradiologic and metabolic investigations.

Breastfeeding programme--right policy, wrong target?

To assess the knowledge of breastfeeding management among obstetriciansand the practices being followed in their hospital, 50 obstetricians in private practice in Nagpur, responded to questionnaires having 6 points covering the entire gamut of common issues regarding breastfeeding. All believed that breast milk is best for the baby. It was found that knowledge about various aspects of breastfeeding management is very poor. Unawareness about the adequacy of colostrum for a full term appropriate for date baby was almost universal. While the policy of promoting breastfeeding every year through public programmes is appropriate, the question is who should be the target? Prospective mothers or obstetricians? It is obvious from this study that obstetricians have significant educational needs in the area of breastfeeding management.